Heartburn is a common discomfort characterized by a burning sensation in the chest. It occurs when stomach acid flows back up into the esophagus, the tube that carries food from your mouth to your stomach. This backflow is known as acid reflux. While occasional heartburn is usually not a cause for concern, frequent heartburn could be a symptom of a more chronic condition called gastroesophageal reflux disease (GERD), also known as acid reflux disease.
Recognizing Acid Reflux Symptoms
The primary indicators of acid reflux are:
- Heartburn: This is the hallmark symptom, presenting as a burning pain that rises from your stomach or lower chest up towards your neck and throat.
- Sour Taste: A distinct, unpleasant sour or bitter taste in your mouth, resulting from stomach acid making its way up.
Beyond these core symptoms, you might also experience:
- Persistent Cough or Hiccups: Irritation of the esophagus from acid reflux can trigger a chronic cough or recurring hiccups.
- Hoarse Voice: Acid can irritate the vocal cords, leading to a scratchy or hoarse voice.
- Bad Breath: The reflux of stomach contents can contribute to persistent bad breath.
- Bloating and Nausea: Increased gas and a feeling of sickness can sometimes accompany heartburn.
These symptoms often worsen after meals, particularly large ones, when lying down, or bending over, as these positions can facilitate stomach acid reflux.
Common Heartburn Causes and Risk Factors
Many individuals experience heartburn occasionally, and often, there isn’t a single identifiable cause. However, several factors can trigger or exacerbate heartburn and acid reflux:
- Dietary Triggers: Certain foods and beverages are known to relax the lower esophageal sphincter (LES), the muscle that prevents stomach acid from flowing back up. These include:
- Coffee and Caffeinated Drinks
- Tomatoes and Tomato-based Products
- Alcohol
- Chocolate
- Fatty Foods
- Spicy Foods
- Excess Weight: Being overweight or obese increases pressure on the abdomen, which can force stomach acid into the esophagus.
- Smoking: Smoking weakens the LES and reduces saliva production, which helps neutralize stomach acid.
- Pregnancy: Hormonal changes during pregnancy, specifically increased progesterone and estrogen, can relax the LES. The growing uterus also puts pressure on the stomach. Learn more about indigestion and heartburn in pregnancy.
- Stress and Anxiety: Stress can impact digestive function and may worsen heartburn symptoms.
- Hormonal Fluctuations: Increases in hormones like progesterone and estrogen can relax the LES.
- Certain Medications: Some medications can contribute to heartburn, including:
- Anti-inflammatory Painkillers: Such as ibuprofen.
- Hiatus Hernia: This condition occurs when part of the stomach protrudes through the diaphragm and into the chest cavity, potentially weakening the LES. Read more about hiatus hernia.
- Stomach Ulcers: Open sores in the stomach lining can sometimes contribute to acid reflux. More information on stomach ulcer.
- Bacterial Infections: Certain bacterial infections in the stomach can disrupt normal digestive processes and increase acid production.
Self-Care Strategies for Heartburn Relief
Fortunately, many cases of heartburn can be managed effectively with lifestyle adjustments.
Recommended Actions (Dos)
- Eat Smaller, More Frequent Meals: Large meals can put pressure on the stomach and increase the likelihood of acid reflux. Opting for smaller, more frequent meals throughout the day can help.
- Weight Management: If overweight, losing even a modest amount of weight can significantly reduce heartburn symptoms by decreasing abdominal pressure.
- Stress Reduction Techniques: Incorporate relaxation techniques like yoga, meditation, or deep breathing exercises to manage stress levels.
Actions to Avoid (Don’ts)
- Identify and Avoid Trigger Foods and Drinks: Keep a food diary to track your meals and heartburn episodes to pinpoint specific foods that worsen your symptoms and limit or avoid them.
- Avoid Late-Night Eating: Give your body time to digest food before lying down. Refrain from eating for at least 3 to 4 hours before bedtime.
- Loose-fitting Clothing: Tight clothing around the waist can constrict the stomach and increase pressure. Wear looser clothing, especially after meals.
- Quit Smoking: Smoking has numerous negative health impacts, and worsening heartburn is another reason to quit.
- Limit Alcohol Consumption: Alcohol can relax the LES and irritate the stomach lining, contributing to heartburn.
- Consult Doctor Before Stopping Medications: If you suspect a medication is causing heartburn, talk to your doctor before discontinuing it, as there may be alternative treatments.
Elevating the head of your bed can also provide relief. By raising the head of your bed by 10 to 20cm (4 to 8 inches) using wood blocks or bed risers, you can use gravity to help keep stomach acid down. Ensure that it’s the entire bed head that is elevated, not just your head with extra pillows, as this can increase pressure on your abdomen, potentially worsening symptoms.
When to Seek Help: Pharmacist and Doctor Advice
Pharmacist Support
For occasional heartburn, a pharmacist can offer valuable advice and over-the-counter remedies. They may recommend:
- Antacids: These medications neutralize stomach acid, providing quick, short-term relief. Learn more about antacids.
- Alginates: These create a protective barrier on top of the stomach contents, preventing acid reflux.
It’s most effective to take these medications with food or shortly after eating, when heartburn is most likely to occur. While helpful for symptom management, these over-the-counter options don’t address the underlying cause of frequent heartburn and are not intended for long-term use. If you are pregnant, consult a pharmacist for safe medication options.
Find a pharmacy near you
When to Consult a Doctor (GP)
It’s advisable to see a doctor (General Practitioner or GP) in the following situations:
- Persistent Heartburn: If lifestyle changes and pharmacy medications don’t provide relief.
- Frequent Heartburn: If you experience heartburn most days.
- Additional Symptoms: If heartburn is accompanied by other concerning symptoms like:
- Food getting stuck in your throat (dysphagia)
- Frequent vomiting
- Unexplained weight loss
A GP can investigate further, rule out more serious conditions, and prescribe stronger treatments if necessary. If your symptoms worsen at any point, promptly contact your GP, use the NHS 111 online service 111.nhs.uk or call 111 for guidance.
Medical Treatments for Heartburn and Acid Reflux from a GP
If you have been diagnosed with acid reflux or GERD, a GP may prescribe:
- Proton Pump Inhibitors (PPIs): These medications, such as omeprazole, lansoprazole, and pantoprazole, significantly reduce stomach acid production.
PPIs are typically prescribed for a course of 4 to 8 weeks, depending on the severity of your condition. If symptoms return after stopping medication, consult your GP, as long-term management may be needed.
Alternative Medications
If PPIs are not effective, your doctor might suggest:
- H2 Receptor Antagonists: Such as famotidine, these medications also reduce acid production, although generally less potently than PPIs.
Further Tests and Treatments for Severe Cases
For severe heartburn or acid reflux that doesn’t respond to medication, or if complications are suspected, a GP may refer you to a specialist for:
- Diagnostic Tests:
- Gastroscopy: A procedure where a thin, flexible tube with a camera is inserted down the throat to visualize the esophagus and stomach, helping identify the cause of symptoms. Learn more about gastroscopy.
- Bacterial Infection Testing: Tests to detect Helicobacter pylori (H. pylori) bacteria, which can contribute to heartburn and ulcers. If present, treatment involves antibiotics and PPIs.
- Surgical Options: In rare cases, surgery on the stomach or esophagus may be considered to strengthen the LES and prevent acid reflux.
Page last reviewed: 20 November 2023
Next review due: 20 November 2026
